If you are severely sick and unable to make decisions or speak, do your loved ones know how you would want to be cared for?

“When we ask patients who can speak on their behalf during a medical emergency, most of the time, they can’t answer us,” said Cindy Lau, Principal Clinical Co-ordinator from the Advance Care Planning (ACP) programme at NHCS.

We cannot avoid or preempt medical emergencies. When that happens, it is important that the affected patient has someone whom they trust to convey how they wish to be cared for to the medical team.

ACP is for everyone

Disease does not discriminate.

ACP is for everyone of all ages, health conditions and anyone who is mentally sound. It is the process of planning for your future health and personal care. It is about having a conversation with your loved ones on your personal values and beliefs, how these affect your healthcare preferences in difficult medical situations, and deciding who can be your voice when you become very ill.

Simply put, ACP is about making your personal wishes known early so that in a medical emergency, your loved ones and caregivers do not have to guess what you want or do not want. It is a plan which should be updated as preferences change and is not legally binding.

Assoc Prof David Sim, Senior Consultant from the Department of Cardiology overseeing the programme, emphasised, “It is not solely about issues concerning end of life but more of the wishes of patients at all stages of their diseases.”

Misconceptions

“We have been called rude names, screamed and shouted at by angry patients and their next-of-kin,” shared Cindy.

She added that when they first implemented the programme in 2013 at the inpatient wards, the concept was relatively new in Singapore and the awareness of ACP was low. Given that traditional Asian cultures are comparatively more conservative as compared to the West, the subject of ACP was considered a taboo to many in Singapore.

The duo screens patients and engages them on the topic of ACP on a daily basis.

Jane Wong, Senior Clinical Coordinator, said that many of their patients are confused by ACP, Lasting Power of Attorney and Advance Medical Directive, “There is a misconception that these terms all mean the same thing or that ACP was about after-life planning. In the early days, some patients even thought that we were selling insurance!”

These misconceptions have no doubt made the work of ACP more challenging especially when they have to broach the topic with patients in poorer health condition.

“We have seen some improvements over the years. People are now more open-minded and willing to talk to us. Perhaps there are more channels to receive information about ACP and awareness has increased,” Jane said. The programme has evolved since its early days and at present, the team sees outpatients, and inpatient referrals.

Living well matters

Living well means different things to different people. It could mean spending quality family time to one and exploring the world to another. In the same vein, ACP helps you to think about what living well means to you and in particular, how you can define for yourself, a life well lived till the very end.

Held in conjunction with National ACP Week 2019, a photography exhibition showcasing pictures taken by SingHealth professionals depicting what living well means to them, is currently on display along the NHCS B1 underpass.

“At the end of the day, we know ourselves best. Shouldn’t we ensure our care wishes are made clear to our family while we are still healthy? Give yourself peace of mind and assure your loved ones on your decisions when the moment arrives.”